Maggie McKay (Host): Oh, baby! Sometimes trying to conceive is harder than it sounds. So today we're going to discuss some helpful tips about women's health with Obstetrician and Gynecologist, Dr. Andrea Richmond-Mart. Welcome to the Better Health Podcast from Tidelands Health. I'm your host, Maggie McKay. Thank you so much for being here, Dr. Richmond-Mart. It's great to have you.

Andrea Richmond-Mart, MD: Thank you for having me.

Host: Let's dive right in and find out what a woman can do right now to help increase her chances of getting pregnant.

Andrea Richmond-Mart, MD: I mean, healthy diet and regular exercise is always helpful. If you're smoking, quit. Smoking cessation is important. Limiting alcohol intake. Ideally, we'll say less than three drinks a week. And those are kind of the big starting factors. Also starting a prenatal vitamin to have some of those extra nutrients on board.

Host: What about sugar?

Andrea Richmond-Mart, MD: So really, we encourage a healthy diet, but a lot of studies have been done about if particular diets enhance or affect fertility, and they really haven't shown to make a difference. Now, however, with that said, you still want to do everything in moderation. They haven't showed that eating certain foods or eliminating certain types of foods has affected fertility.

Host: Well, that's good news. What's the story on ovulation tracking? Is that a thing?

Andrea Richmond-Mart, MD: Yes. So ideally, when you're trying to think about conceiving, the highest chance of fertility is going to be in what we call the fertility window. That's the five days prior to ovulation, as well as the day of ovulation. So many women will use a app that can help to track their cycle and calculate that fertility window for them.

Other ways to do it is measuring your basal body temperature or tracking cervical mucus. And then also they have ovulation devices that help you determine when you've ovulated.

Host: Like a pregnancy test?

Andrea Richmond-Mart, MD: it's similar in that it works the same way, but it's actually looking for a specific hormone that peaks prior to ovulation, which isthe release of the egg so, it's actually looking for a hormone called LH.

Host: You mentioned taking prenatal vitamins. How do they help?

Andrea Richmond-Mart, MD: Well, the big thing, we like to have them on board at least a month prior to pregnancy. They have folic acid, which is really important for development of the spine and trying to prevent neural tube defects. We like women to take at least 400 micrograms of that, and so that's going to be in the prenatal vitamin. And then it just also has other supplements like vitamin B12 and other vitamins that just generally are healthy.

Host: And an added bonus is the great hair, right? It makes your hair so full. At least it did for me. I don't know about other people, but my friends said the same thing. They didn't want to stop taking them.

Andrea Richmond-Mart, MD: It can, and it's fine to take them even if you're not trying to get pregnant.

Host: Are there any medications a woman should get off of, if she's trying to get pregnant, are there any that are not a good idea to be on?

Andrea Richmond-Mart, MD: So if someone comes in for a preconception visit, then yes, we want to look at their medicines. And there are certain ones that need to be avoided in pregnancy. And so that's certainly something that we would talk about. There's none that will inhibit pregnancy, like interfere with becoming pregnant, but again, some of the hypertensive medications and things like that have certainly been linked to causing birth defects.

Host: And you mentioned diet, we talked about that, and you touched a little bit on exercise, but, how much is too much? I remember one of my friends was trying to get pregnant and, getting shots, or maybe it was in vitro, and just could not do anything because she didn't want to take a chance. What's the story with exercise?

Andrea Richmond-Mart, MD: So if you are used to working out a certain amount, then that's completely fine. Now where it can be a factor is if you are underweight. So if your BMI drops below 18, then the body starts sourcing nutrients to other areas and you may not ovulate regularly and it can affect your fertility.

Host: I know it's such an emotional journey. Can you talk about fertility and at what point in somebody's journey should they consult an OBGYN for help?

Andrea Richmond-Mart, MD: You're exactly right. I think there's a lot of emotions that come with it. And some of it's just the unknown. Typically when we're counseling women about trying to conceive, of course, we'll tell them to come off any pills or anything that they're using for contraception. Okay. And once they're having regular cycles and really start tracking their cycles so that they're having intercourse during that peak fertility time. And 80 percent of couples are going to conceive within six months of that time. Okay, however, for women that are less than 35, we give them up to a year.

So if we've been trying for a year, and we haven't conceived, then it's time to talk to your OBGYN, about what could be going on. Do we need to get a fertility specialist involved and things like that? For women who are older than 35, we shorten that time to six months.

Host: So the term senior mom still is 35 and above, because I was shocked when they looked at my chart and they're like, Oh, you're a senior mom. And like, I am?

35?

Andrea Richmond-Mart, MD: Yes, so typically we use the term advanced maternal age. But yes, there's no nice way of putting it. We typically avoid that term when we're counseling patients.

Host: How do you keep somebody's spirits up and encourage them to keep trying? Because there's so many people who just try month after month after month and it doesn't happen. How do you counsel patients like that?

Andrea Richmond-Mart, MD: Just going over the statistics with them, right? So, you know, if you've only been trying three months, letting them know, Hey, let's give it another three months, because again, the majority of couples are going to conceive during that time. If it's starting to become a point of stress that's affecting relationship, affecting their personal life, there's no rule that says you can't start an infertility workup sooner than six months.

So, sometimes patients just want to hear from the specialist and want a referral to reproductive endocrinology sooner rather than later, and that's not a problem either.

Host: So what are the options now? There's in-vitro and artificial insemination. What else? Shots?

Andrea Richmond-Mart, MD: Donor egg would be an option. Some people have to use donor sperm. But those are still going to be the main option. So what we call IUI, intrauterine insemination. Typically that's going to be used for couples where, when we do the workup, like sperm count's normal, everything's normal. We know that ovulation is occurring regularly and the tubes are open. Okay. IVF is going to be more if oftentimes, like again, if something's going on where the sperm count's really low, then doing IUI isn't reasonable, because even if you put the sperm directly into the uterus, there's just not enough of them to guarantee fertilization, so IVF is the option, and then, we have some women who have delayed childbearing till later.

 And they may be in their forties before they decide they want children. At that point, the quality of our eggs just isn't what it used to be. So, sometimes they may have success with IVF. But sometimes they might require a donor egg.

Host: Of all the options, is there one that statistically has the best results? Like people get pregnant the most on one option?

Andrea Richmond-Mart, MD: IUI is going to convey the same rate of pregnancy as if you conceived naturally, right? So we say 20 percent chance each month of becoming pregnant, and same with IUI, basically you're just trying to, increase the likelihood that the sperm will meet the egg. Okay. Now with IVF and a good quality egg that's been tested, that can go up to 65%.

Host: So is there anything else in closing that you'd like to add that you would like people to know?

Andrea Richmond-Mart, MD: I think that everybody's journey is different and there's, as we've discussed, a lot of emotions attached to it and I think all of those emotions are normal as well. And sometimes if people are feeling frustrated or alone or like nobody else has gone through this; then that's a good time to reach out to your OBGYN.

Because oftentimes I'll find patients who are kind of there and then us just talking through it really makes a big difference for them.

Host: Well, thank you so much for sharing your expertise. We appreciate it. It was fascinating. I learned a lot.

Andrea Richmond-Mart, MD: Well, good. Well, thank you so much for having me.

Host: Again, that's Dr. Andrea Richmond-Mart. And for more information, you can call 1-866-TIDELANDS or visit tidelandshealth.org. Make sure to subscribe to Better Health Radio in Apple Podcasts, Google Play, or wherever you listen to your podcasts for more episodes. I'm Maggie McKay. Thanks for listening to the Better Health Podcast from Tidelands Health.